Heel Striking Increases Risk of Shin Injuries

Shin injuries are most likely more common in heel strike running because knee stiffness is greater at touchdown as compared with forefoot running where the knee is more compliant and therefore, less stiff.

Shin Injuries Higher in Heel Strike Running

Heel Striking Increases Risk of Shin Injuries

A study by Milner et al. revealed that runners who had suffered shin injuries, such as a tibial stress fracture, in the past ran with stiffer knees compared to healthy runners.

  • Their data showed that stiff knees at touchdown (initial loading), increased tibial shock –high tibial shock of course, causes tibial stress fracture, during running.

What causes knee stiffness when running?

The runners in the study were heel strike runners whereby at heel strike, the knee joint is fully extended which causes the knee to stiffen-up.  The researchers noted that initial loading in heel strike running led to greater changes in vertical loading and knee moments which were considered key in the development of a tibial stress fracture, suggesting that an unbent, stiff knee at touchdown results in a sudden loss of impact absorption.

Running with stiff knees increases risk of tibial stress fracture
In heel strike running, the knee increases in stiffness as it extends and straightens to set up for heel strike. This reduces knee flexion which is correlated with higher tibial shock at touchdown.

Just to recap, at heel strike, the knee is straight (less flexed) and is more difficult to use as a shock absorber because less knee flexion coincides with greater knee stiffness. Conversely, other reports confirmed that greater knee flexion at touchdown reduces peak vertical forces, making for a softer landing during running.

Forefoot Running Reduces Tibial Shock

Knee flexion is more valuable with forefoot running because initial loading is considerably less at touchdown compared to heel strike running.

Initial loading is less destructive on the tibia in forefoot running due to reduced heel vertical velocity. In research circles, evidence is showing strong associations with reduced impact loading and reduced heel vertical velocity in runners. Collectively, greater knee flexion and lower heel vertical velocities reduces tibial shock, making the tibia less sensitive to fracture when forefoot running.

Although, heel strike runners who have transitioned to forefoot running boasts a number of success stories, support for its effectiveness on preventing tibial stress fracture is mainly anecdotal. Nevertheless, more runners are committing to forefoot running for injury prevention purposes and is gathering steam in the scientific and clinical communities.

More From Run Forefoot:

The best way to polish your forefoot running form and build better foot strength is by running barefoot.

The differences between forefoot striking and heel striking.

Find out why cushioned running shoes leads to more injury in runners.

What is proprioception and why it’s important for running properly.

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Gerritsen KGM, van den Bogert AJ, Nigg BM. Direct dynamics simulation of the impact phase in heel-toe running. J Biomech. 1995;28(6):661–8.

Milner et al. Are knee mechanics during early stance related to tibial stress fracture in runners? Clin Biomech, 2007; 22:697-703.

Milner, C.E., Ferber, R., Pollard, C.D., Hamill, J., Davis, I.S., 2006. Biomechanical factors associated with tibial stress fracture in female runners. Med. Sci. Sports Exerc. 38, 323–328.

Bretta Riches

"I believe the forefoot strike is the engine of endurance running..."

BSc Neurobiology; MSc Biomechanics candidate, ultra minimalist runner & founder of RunForefoot. I was a heel striker, always injured. I was inspired by the great Tirunesh Dibaba to try forefoot running. Now, I'm injury free. This is why I launched Run Forefoot, to advocate the health & performance benefits of forefoot running and to raise awareness on the dangers of heel striking, because the world needs to know.
Bretta Riches

P.S. Don't forget to check out the Run Forefoot Facebook Page, it's a terrific place to ask questions about forefoot running, barefoot running and injury. I'm always happy to help!

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